The New England Journal of Medicine, open access, Plan S, and undeclared conflicts of interest

The New England Journal of Medicine disapproves of open access publishing and Plan S. https://www.nejm.org/doi/full/10.1056/NEJMms1900864 There’s nothing surprising in that. (The opposite would have been surprising.) What is surprising is that the journal does not declare its substantial conflicts of interest, when the International Committee of Medical Journal Editors, of which it is a founding and prominent member, has made clear for 30 years that all conflicts of interest should be declared.

The New England Journal of Medicine is immensely profitable (although we don’t know exactly how profitable), and those profits—and the compensation and livelihood of its employees—are potentially disrupted by open access and particularly Plan S, the European plan to extend open access publishing.

My guess has been that the New England Journal of Medicine has an income of about $100 million with a profit margin about 30%. As a former chief executive of the BMJ Publishing Group who saw the annual accounts of all our journals, I’ve guessed this with some confidence. It’s harder to be sure about the revenue than the profit margin, but I doubt that it’s as low as $50 million or as high as $150 million. The profit margin is fairly standard for well-established journals—and is known to be the case for the scientific journals of what was called Elsevier, the world’s largest scientific publisher. This is a high margin for a journal when the value is in the science, which the publishers are given for free, not in the trivial processes that journals apply.

I have had to guess the profits of the New England Journal of Medicine a because the accounts of the journal are not published—despite many challenges for them to do so. But the Massachusetts Medical Society, the owners of the journal and a not-for-profit organisation (which are also known as not-for-loss organisations and may pay their officers handsomely) have to submit a tax return, and the submission for the year ending May 2017 makes interesting reading. https://projects.propublica.org/nonprofits/organizations/42050773/201841029349300719/IRS990

The overall income of the society was £123 million, and the surplus £12 million. The income from publishing was £103 million. The society publishes more than the New England Journal of Medicine, so this is not all income from the journal—but we can be sure that most of it is the journal. It’s not possible to work out the profit margin, but I presume that most of the £12m surplus of the society comes from the journal as most if its other activities will carry costs and not be profitable.

What it is possible to know exactly from the return is the compensation of the senior editors. For Jeff Drazen, the editor-in-chief, it was $703 324. This is compensation and so probably includes health insurance and perhaps pension payments. Plus salaries are higher in the US than most countries, with star medical academics earning large sums. It may even have been that Drazen took a pay cut to join the journal or that the society had to match his salary in order to get him to take the job. Nevertheless, the sum will cause most people to gasp and wonder if what he does—“taking in other peoples’ washing,” as my predecessor as editor of the BMJ described the job—is worth so much. (I was paid £120 000 (then about $150 000) when I was the editor of the BMJ—and I was the chief executive of the group as well as the editor.)

Ted Campion, the executive editor, was paid $393 059; Mary Hamel, the executive deputy editor, $328 462; Julie Ingelfinger, $321 468; and Christopher Lynch, vice-president, publishing 472 499. (It looks in passing as if the journal may have gender pay gap). These generous incomes are all threatened by open access and Plan S.

None of this is declared in the article questioning open access and Plan S. Indeed, the author, Charlotte Haug declares both that she has no conflict of interest and that she is employed by the journal as international correspondent. https://www.nejm.org/doi/suppl/10.1056/NEJMms1900864/suppl_file/nejmms1900864_disclosures.pdf These seem to me incompatible declarations: I can’t help reflecting that if I read an editorial on a drug manufactured by GSK that was written by an employee of the company that would seem to me to be a conflict of interest.

But I doubt that the salary of Haug is $700 000, and it is surely the conflict of interest of the journal, the owners, and the senior editors that is most relevant—and should at least be declared, preferably in detail.

Conflict of interest: I was until 2004 the editor of the BMJ and the chief executive of the BMJ Publishing Group. As I write in the blog, I was paid about £120 000. I now have a pension of £60 000 from the BMA, the owners of the BMJ. I’ve been an enthusiast, even a zealot, for open access since the 90s (before the term open access was coined). I was on the board of the Public Library of Science for seven years, which was an unpaid position, and I have consulted for F1000Research, earning perhaps £5000 in total. I chair Open Pharma, for which I’ve been paid about £9000 over three years. Jeff Drazen and I shared a platform at a conference in Dublin, which was described by somebody in the audience as a “cage fight.”